Archived: Trewithen

Trewithen provides care and accommodation for up to five people who are autistic. At the time of the inspection four people were living at the service. The service is part of the Spectrum group who run several similar services throughout Cornwall, for people living on the autistic spectrum.

People’s experience of using this service and what we found

The provider had completed appropriate checks when they recruited permanent staff. However, they had not assured themselves a staff member who had been employed via a staffing agency, working long term in the service and also living there, was of good character or suitable to work with vulnerable adults.

A staff member who had been working at the service since December 2021 had only received a one-day induction and no further training.

Risks related to the safety of the service had not always been assessed or acted upon.

Audits and action plans had not identified all the areas for improvement identified during this inspection; for example, fire risks, staff recruitment and training. This meant people were exposed to the risk of harm.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People had been supported to have their medicines reviewed and reduced, where appropriate.

Staff had received safeguarding training, and information about who to contact with any safeguarding concerns was displayed in the service.

Staffing had been used flexibly to help ensure people received the support they needed.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

Staff understood people’s preferences and enabled them to make choices about how they spent their day; however they had not been consulted for their views about a staff member living in the service. People’s records described what support they required to maintain their independence. People’s records described how people needed information presenting to them to help them understand it. Staff had developed personal communication dictionaries for people which helped them develop a more consistent understanding of people.

Right care:

People received person-centred care; however, at times, the language staff used did not reflect this ethos. Staff were aware of the risks of social isolation but balanced this with protecting people’s privacy and dignity. Records showed the aims and ambitions for people, why this would benefit them, steps they needed to take to achieve them, and who they would need to help them. The environment had been reviewed and adapted to meet people’s sensory needs and preferences.

Right culture:

The registered manager was aware of best practice guidance and was supporting the team to identify any improvements that could be made. External professionals had been used to help ensure people were receiving the right care and support for their needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 18 April 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Enforcement and recommendations

We have identified breaches in relation to reducing risks, training and the running of the service. We have made three recommendations in relation to medicines management and person-centred care. Please see the action we have told the provider to take at the end of the full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This unannounced comprehensive inspection took place on 7 April 2018. We last inspected Trewithen in February 2016, we had no concerns at that time and we rated the service as ‘Good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The atmosphere at Trewithen was busy and friendly. People were supported to go out during the day. When spending time in the service people busied themselves with household tasks and spent time with staff.

Risks were clearly identified and assessments guided staff on the actions they should take to minimise any risks. Appropriate safety checks were completed to help ensure the building and utilities were safe. The environment was clean and well-decorated. Plans were in place to improve the kitchen area.

Systems for the management and administration of medicines were robust. Medicine Administration Records were clear and indicated when anyone had received medicines to be used ‘as needed.’

Some people required regular monitoring to enable staff to identify if they were at increased risk of deteriorating health. We found some gaps in monitoring records and have made a recommendation about this in the report.

Care plans identified how people preferred to be supported and how much support they required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The manager had introduced a new audit tool to help ensure any restrictive practices remained necessary and proportionate.

Technology was used to help improve the delivery of effective care. Spectrum had introduced an electronic system for the recording of daily notes, appointments and incidents and accidents. Staff had received training in how to use the system.

Staff were supported through a system of induction, training, supervision and staff meetings. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. There were enough staff to support people safely and allow them to take part in individual activities. Regular bank staff supported the core staff team as necessary.

People and their families were asked for their views of the service. Any complaints were taken seriously and addressed in line with policies and procedures.

The service was overseen by a manager. They were supported by a deputy manager who was based at Trewithen. The deputy manager had some protected time to complete administrative tasks. Key workers were assigned to individuals to enable them to focus on their care planning and organise any health appointments. The manager had introduced new systems to help drive improvement in the service.

Further information is in the detailed findings below.

Trewithen provides care and accommodation for up to five people who have autistic spectrum disorders. At the time of the inspection four people were living at the service. There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Trewithen is part of the Spectrum group which provides services to people living with autism in Cornwall. The service is a modern property located on the outskirts of Camborne. It is within walking distance of the town which has good transport links to the rest of the county. The premises were well maintained, pleasant and roomy. There were two large living rooms and a large kitchen/dining area allowing people choice about where and with who they spent their time. People had large en-suite bedrooms which had been decorated and furnished in line with their personal preferences. The garden was pleasant and people spent time in it either working or enjoying the surroundings.

Recruitment practices helped ensure staff working in the service were fit and appropriate to work in the care sector. Staff had received training in how to recognise and report abuse. They were clear about how to report any concerns and were confident any allegations made would be appropriately investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet people's needs and keep them safe.

Staff had a good understanding of people’s needs and support plans included clear information about how people chose and preferred to be supported. There were clear guidelines for staff on how they could support people to help them avoid becoming distressed. When people did become anxious the care plans informed staff on what actions to take. This helped ensure staff took a consistent approach to supporting people.

Staff monitored people's behaviour and routines in order to help ensure people's needs were not negatively impacting on others. Families and other professionals were involved in regular discussions about how best to support people. The registered manager told us they were continually assessing people's needs to check these were being met.

People's individual abilities and strengths were recognised and respected. People received as much support as they needed but were encouraged to be independent wherever possible. Staff took a flexible approach to support, according to the needs of the individual. People approached staff for assistance and reassurance as they needed it and staff responded with understanding and good humour.

The registered manager and staff had a clear understanding of the Mental Capacity Act 2005, and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

Information was presented in easy read format to aid people's understanding and facilitate meaningful involvement. Care plans contained one page profiles and simple text was supplemented with pictures. Communication tools were available and staff supported people to use these to plan their days.

The registered manager took an active role within the home. There were clear lines of accountability and responsibility within the management structure. Tasks

were delegated to help ensure the smooth and efficient running of the service. There was a key worker system in place. Key workers had oversight of each individual's plan of care.

We spoke with two relatives, the manager and three members of staff. Relatives we spoke with told us they were happy with the care and support their relative received. Comments included; 'Absolutely marvellous' and 'I'm very happy, we couldn't ask for anything better'.

We examined people's care files and found the records were generally up to date and had been reviewed as the person's needs/wishes changed. The records showed that people went out frequently and saw healthcare professionals when they needed them.

Medication was administered appropriately.

People who used the service had a choice of suitable and nutritious food.

Systems for safeguarding people from abuse were robust. Legal safeguards, which protect people who are unable to make decisions about their own welfare, were understood by staff and used to protect people's rights.

People who used the service were protected because the quality of the care and support provided was regularly assessed and monitored.

We saw that people's privacy and dignity was respected by the way that staff discreetly assisted people with their personal care.

We examined people's care files and found the records were up to date and reviewed as the person's needs/wishes changed.

We found that people who used the service were involved in making day to day decisions and participated in some domestic tasks at home. The records showed that people went out frequently and saw healthcare professionals when they needed them. Medication wasa administered appropriatley, but robust recording was needed to ensure that all medications were accounted for.

Staff said they had received sufficient training to enable them to carry out their roles competently and felt there were sufficient staff on duty.

Systems for safeguarding people were satisfactory. Legal safeguards, which protect people unable to make decisions about their own welfare, were understood by staff and used to protect people's rights. Recruitment processes are robust.